Healthcare Provider Details

I. General information

NPI: 1427031715
Provider Name (Legal Business Name): BRIAN R. EMERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3735 GLENLAKE DR STE 250
CHARLOTTE NC
28208-6866
US

IV. Provider business mailing address

PO BOX 117661
ATLANTA GA
30368-2691
US

V. Phone/Fax

Practice location:
  • Phone: 704-749-5800
  • Fax: 704-626-3237
Mailing address:
  • Phone: 704-749-5800
  • Fax: 704-626-3237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME91611
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD49728
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberMD 60077682
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2022-00544
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: